What Every Woman Needs To Know About Fertility Struggles, From A Doctor
Fertility is a top concern for women today, whether they are in their 20s or 30s, or now even their 40s. According to the CDC, over 10%1 of American women struggle with fertility—that’s over 7 million women.
And yet from my perspective as a practicing physician, too many women are told they need procedures like IUI and IVF without anyone looking under the hood and investigating why they can’t get pregnant. For example, I see patients every day whose doctors haven’t diagnosed the thyroid imbalances, cortisol issues, blood sugar elevations, or inflammation that can often contribute to fertility problems.
What's at the root of your fertility struggles?
Take for example my 33-year-old patient who wanted to get pregnant but had irregular periods and was unable to time when she was ovulating. We diagnosed her with insulin resistance and food sensitivities to gluten and dairy. When she cut out these foods and balanced her blood sugar, her periods became regular and she got pregnant easily.
Another example is a 29-year-old patient who suffered pregnancy loss. We learned through our routine testing—testing her OB-GYN hadn’t done—that she had low thyroid function. We helped her optimize her thyroid with a natural thyroid hormone, and she got pregnant two months later, this time keeping the pregnancy and having a healthy baby boy.
A third example is a woman in her late 30s who hadn’t had her period in two years. In addition her AMH—antimullerian hormone—was low and so she had little egg reserve. She was possibly not even a candidate for egg harvesting and IVF. She was also told she was probably in early menopause. We tested her and found that not only was she not in early menopause, but she had high prolactin levels, a hormone that is usually associated with breast milk production and had shut down her menstrual cycle. With a medication to lower prolactin and progesterone support, she was able to get her cycle back and conceive on her own.
Above all, make sure you have a support system in place.
The common thread for all of these women, however, was that they needed two things they hadn’t counted on to get pregnant. First, a caring, thorough doctor who spent the time getting to know them as a whole person, knew what tests to run, and whose goal was to help them get pregnant naturally—without a medical partner aligned with their goals, they didn’t have a shot.
The second thing they needed was time. Too many women come to see me day one and say, "I want to optimize my health, I have six chronic issues I’ve had for years, and oh by the way, I want to start trying to get pregnant next month." I gently have to tell them that their symptoms didn’t start yesterday so they aren’t going to fix them today. To optimize your health you need to replete nutrients, detoxify toxins, eliminate triggers, and test in order to understand how your body is functioning now so we can help you heal.
So in this way, think of your fertility year as an amazing opportunity to improve your overall health and well-being before you want to get pregnant. Now is the time to focus on you, reset, identify and address underlying health issues, and find your highest expression of balance. There is no better way to head into pregnancy than that.
If you’re not sure where to start, here are five simple steps I recommend for women who are thinking about becoming pregnant in the next couple of years. IVF isn’t going anywhere, but your fertility is something you can improve today.
Here's how to improve your fertility starting now:
Make sure your doctor tests for nutrient deficiencies, toxins like heavy metals, genetics with implications for pregnancy like MTHFR, and of course hormones, including forgotten hormones like cortisol, DHEA, prolactin, and insulin, which can have a much bigger impact on fertility than estrogen and progesterone. You might also do a test like Counsyl, a genetics screen for common inherited diseases, which your OB may run as part of your annual visit.
2. Eat clean and restore.
At my practice, Parsley Health, we guide you through a 30-day elimination diet cutting out common inflammatory foods like gluten, dairy, grains, and sugar. Often women are shocked at how their sleep and energy change when they change their diet, not to mention they lose weight and their menstrual cycles become regular. We also help you restore nutrients you are low on like magnesium and B vitamins.
My motto? Make clean eating simple and enjoyable.
Detoxification is a process that really begins month two of our program and can take as long as three to six months. It includes reducing exposure from heavy metals like mercury from seafood and metal dental fillings as well as using natural supplements like B-vitamins, liver-stimulating bitters, and even metal binders to lower the body’s total toxin burden.
It also includes resolving digestive issues—if you’re not pooping regularly or have a lot of gas and bloating, then you’re not detoxifying regularly either.
Finally, it includes an environmental detoxification—now is the time to get rid of cleaning products, makeup, and moisturizers with chemicals like phthalates and parabens, oxybenzone, BPA, and BPS. It's more effective to stop using toxic products now than during your pregnancy.
This is the time to focus on you and your overall health and well-being, not to fixate on getting pregnant like your life depends on it. Stress is one of the No. 1 drivers of digestive issues, autoimmune disease, PMS and irregular cycles, and fertility challenges. If you are chronically stressed and anxious, not sleeping well, and exhausted, you need to begin to learn stress management tools like mindful breathing, yoga, and meditation. You’ll need these tools more than ever once you’re a mom, so now is the time to practice them. My course on stress is a great place to start.
5. Start your engines (aka your prenatal nutrients).
(And stop other unnecessary supplements.) If you are truly ready to start "trying"—a word I can’t stand because it adds stress (I prefer that you start "not not trying" so that your conception feels effortless, not like another task the success or failure of which you will be judged upon! Anyway…), but if you are—supplements to keep on hand are probiotics, magnesium, a high-quality fish oil, and vitamin D and in some cases other supplements as directed by your doctor for your particular situation. From there, start a high-quality prenatal vitamin.
A good prenatal has the right kind of B vitamins for you (the methylated kind if you have MTHFR genetic variations like I do), high-quality sourcing of ingredients, and appropriate levels of key nutrients like DHA fatty acids, which feed the baby’s growing brain, vitamin A, iron, and folic acid. Do not buy supplements at the grocery store or take the samples your OB gives you for free—I can’t tell you how many women have shown me prenatals their OB gave them that contain toxic dyes and chemicals! This isn't to scare you, it's just a reminder to be mindful of the ingredients.
Getting pregnant usually doesn’t happen overnight. It takes time and effort and support from friends, family, and a doctor who takes the time to get to know you and your body. It’s one of the most difficult times in a woman’s life, but it should also be one of the most special. I want women to look at the time when they are working toward building a family as family time itself.
Robin Berzin, M.D., is a functional medicine physician and the founder of Parsley Health. She currently lives in New York, NY and her mission is to make functional medicine affordable and modern, so more people can access a holistic, root-cause approach to health.
A Summa Cum Laude graduate of the University of Pennsylvania, Dr. Berzin went to medical school at Columbia University and later trained in internal medicine at Mount Sinai Hospital. She is also a certified yoga instructor and a meditation teacher, and has formally studied Ayurveda. Dr. Berzin writes for a number of leading wellness sites, and speaks regularly for organizations including the Clinton Foundation, Health 2.0, Summit and the Functional Forum, on how we can reinvent health care.
She's also a mindbodygreen courses instructor, teaching her Stress Solution program designed to help you tune down the stress in your life and tune up your energy and happiness.